Endocrine Abstracts

Cushing’s disease (CD) is a rare condition, associated with significant morbidities.

The long-term morbidities in a series of patients with CD who presented in two tertiary referral centres between 01/1967-06/2009 were assessed. All information was collected as documented in the records of the patients.

224 patients were identified (174 females) with median age at diagnosis 39 years (range 10–76 (females 38 (12–72) – males 40.5 (10–76)) and median follow-up 113 months (0–550) (mean 143 months (±121)). Treatment modalities were: TSA 144 patients (cured 70%), TSA+external radiotherapy 22 (cured 32%), TSA+bilateral adrenalectomy 21 (cured 100%), TSA+bilateral adrenalectomy+radiotherapy 8 (cured 100%), bilateral adrenalectomy 19 (cured 100%), radiotherapy 3 (cured 33%). Two patients are waiting for surgery, 4 had been treated medically due to high surgical risk, and one died before any treatment. The median time between cure and last assessment was 102 months (0–549) (data available for 192 patients (85.7%). At last assessment, 70.5% of the subjects were considered cured (157/224). Morbidity rates and median (range) age at last follow-up were: hypertension 35.3% (79.8% cured – 54 years (17–82)) dyslipidaemia 27.2% (75.4% cured – 52 years (25–82)), DM2 13.4% (66.6% cured – 55 years (18–75)), depression 14.3% (81.3% cured – 60 years (22–78)), osteopaenia/osteoporosis 39.7% (76.4% cured – 52 years (18–78)), cardiovascular disease 9.4% (66.6% cured – 52 years (26–71)), cerebrovascular disease 3.6% (62.5% cured – 59 years (26–71)), kidney stones and/or dysfunction 5.35% (83.3% cured – 48 years (30–69)), gallstones 0.4% (100% cured – 39 years (33–45)).

High proportions of various morbidities in CD rectify themselves after successful treatment but significant morbidities also remain, particularly with regard to hypertension, dyslipidaemia, osteopaenia/osteoporosis and are likely to have an impact on long-term mortality. Whether these morbidities are the result of previous steroid exposure or of possible hypopituitarism remains to be clarified.